Traumatic Brain Injury Sourcebook, 1st Ed.

Preface

ABOUT THIS BOOK

Traumatic brain injury (TBI) occurs when there is a sudden trauma that results in damage to the brain. This can occur when a person’s head violently hits an object or when an object pierces the skull and enters brain tissue. It may occur even without a direct blow to the head, such as when a person suffers a whiplash. Depending on the extent of damage to the brain, the symptoms of TBI can be mild, moderate, or severe. According to the Centers for Disease Control and Prevention (CDC), in 2014, there were about 2.87 million TBI-related emergency department (ED) visits, hospitalizations, and deaths in the United States including 837,000 children.

Traumatic Brain Injury Sourcebook, First Edition begins with basics of the brain. It provides information and facts about traumatic brain injury along with its classifications, symptoms, and potential effects. It offers information on diagnosis, treatment, and surgical options of TBI. It discusses various conditions associated with TBI, such as Alzheimer disease, dementia, Parkinson disease, etc., and deals with the disabilities that may occur as a result of TBI. It talks about various safety measures to be taken to avoid a brain injury. Rehabilitation techniques and caring for those affected with TBI are discussed. Facts about some important clinical trials and research studies on TBI are also provided. The book concludes with a glossary of terms related to traumatic brain injuries and resources for additional help and information.

HOW TO USE THIS BOOK

This book is divided into parts and chapters. Parts focus on broad areas of interest. Chapters are devoted to single topics within a part.

Part 1: Understanding Traumatic Brain Injury begins with a basic description of what the brain is and explains how it functions. It provides information and facts about traumatic brain injury (TBI) along with its classifications, symptoms, and potential effects. It also provides facts about high-risk groups for brain injury.

Part 2: Diagnosis and Treatment of Traumatic Brain Injury provides suggestions on when to seek medical help and what to expect from a healthcare professional. It offers information on diagnosis, treatment, and surgical options for TBI. Emergency treatment guidelines to help people with a severe brain injury are also provided.

Part 3: Conditions Associated with Traumatic Brain Injury talks about the various conditions associated with TBI such as Alzheimer disease, dementia, hypertension, Parkinson disease, posttraumatic stress disorder (PTSD), vision loss, and epilepsy.

Part 4: Disability from Traumatic Brain Injury offers information about severe disabilities resulting from a TBI. It talks about what disability is and explains how to live with a physical disability. It gives an insight into how people with a TBI or other disabilities are being victimized and offers information on how to seek support services.

Part 5: Reducing the Risk of Traumatic Brain Injury provides preventive measures to be taken to stay away from a brain injury. It talks about road safety, workplace safety, playground safety, and sports safety. It highlights the importance of helmets and explains how to use them properly.

Part 6: Living with Traumatic Brain Injury talks about rehabilitation and life after TBI. It explains how to manage specific symptoms caused by TBI and gives information about the role of parents in helping children with TBI. Some useful information on how to care for a person with TBI is also provided.

Part 7: Clinical Trials and Research Studies on Traumatic Brain Injury has basic information on what clinical trials and observational studies are, followed by information on some important clinical trials on TBI.

Part 8: Additional Help and Information provides a glossary of terms related to TBI and lists out the government and private organizations that provide help and support to people with TBI.

BIBLIOGRAPHIC NOTE

This volume contains documents and excerpts from publications issued by the following U.S. government agencies: Administration for Community Living (ACL); Agency for Healthcare Research and Quality (AHRQ); Centers for Disease Control and Prevention (CDC); Child Welfare Information Gateway (CWIG); Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); National Center for Posttraumatic Stress Disorder (NCPTSD); National Highway Traffic Safety Administration (NHTSA); National Institute of Neurological Disorders and Stroke (NINDS); National Institute on Aging (NIA); National Institute on Drug Abuse (NIDA) for Teens; National Institutes of Health (NIH); Occupational Safety and Health Administration (OSHA); U.S. Consumer Product Safety Commission (CPSC); U.S. Department of Veterans Affairs (VA); U.S. Food and Drug Administration (FDA); and USA.gov.

It may also contain original material produced by Omnigraphics and reviewed by medical consultants.

ABOUT THE HEALTH REFERENCE SERIES

The Health Reference Series is designed to provide basic medical information for patients, families, caregivers, and the general public. Each volume provides comprehensive coverage on a particular topic. This is especially important for people who may be dealing with a newly diagnosed disease or a chronic disorder in themselves or in a family member. People looking for preventive guidance, information about disease warning signs, medical statistics, and risk factors for health problems will also find answers to their questions in the Health Reference Series. The Series, however, is not intended to serve as a tool for diagnosing illness, in prescribing treatments, or as a substitute for the physician–patient relationship. All people concerned about medical symptoms or the possibility of disease are encouraged to seek professional care from an appropriate healthcare provider.

A NOTE ABOUT SPELLING AND STYLE

Health Reference Series editors use Stedman’s Medical Dictionary as an authority for questions related to the spelling of medical terms and The Chicago Manual of Style for questions related to grammatical structures, punctuation, and other editorial concerns. Consistent adherence is not always possible, however, because the individual volumes within the Series include many documents from a wide variety of different producers, and the editor’s primary goal is to present material from each source as accurately as is possible. This sometimes means that information in different chapters or sections may follow other guidelines and alternate spelling authorities. For example, occasionally a copyright holder may require that eponymous terms be shown in possessive forms (Crohn’s disease vs. Crohn disease) or that British spelling norms be retained (leukaemia vs. leukemia).

MEDICAL REVIEW

Omnigraphics contracts with a team of qualified, senior medical professionals who serve as medical consultants for the Health Reference Series. As necessary, medical consultants review reprinted and originally written material for currency and accuracy. Citations including the phrase Reviewed (month, year) indicate material reviewed by this team. Medical consultation services are provided to the Health Reference Series editors by:

Dr. Vijayalakshmi, MBBS, DGO, MD

Dr. Senthil Selvan, MBBS, DCH, MD

Dr. K. Sivanandham, MBBS, DCH, MS (Research), PhD

OUR ADVISORY BOARD

We would like to thank the following board members for providing initial guidance on the development of this series:

Dr. Lynda Baker, Associate Professor of Library and Information Science, Wayne State University, Detroit, MI

Nancy Bulgarelli, William Beaumont Hospital Library, Royal Oak, MI

Karen Imarisio, Bloomfield Township Public Library, Bloomfield Township, MI

Karen Morgan, Mardigian Library, University of Michigan-Dearborn, Dearborn, MI

Rosemary Orlando, St. Clair Shores Public Library, St. Clair Shores, MI

HEALTH REFERENCE SERIES UPDATE POLICY

The inaugural book in the Health Reference Series was the first edition of Cancer Sourcebook published in 1989. Since then, the Series has been enthusiastically received by librarians and in the medical community. In order to maintain the standard of providing high-quality health information for the layperson the editorial staff at Omnigraphics felt it was necessary to implement a policy of updating volumes when warranted.

Medical researchers have been making tremendous strides, and it is the purpose of the Health Reference Series to stay current with the most recent advances. Each decision to update a volume is made on an individual basis. Some of the considerations include how much new information is available and the feedback we receive from people who use the books. If there is a topic you would like to see added to the update list, or an area of medical concern you feel has not been adequately addressed, please write to:

Managing Editor

Health Reference Series

Omnigraphics

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Detroit, MI 48226

Part 1 | Understanding Traumatic Brain Injury

Chapter 1 | Brain Basics: Know Your Brain

The brain is the most complex part of the human body. This three-pound organ is the seat of intelligence, interpreter of the senses, initiator of body movement, and controller of behavior. Lying in its bony shell and washed by protective fluid, the brain is the source of all the qualities that define humanity. The brain is the crown jewel of the human body.

For centuries, scientists and philosophers have been fascinated by the brain, but until recently they viewed the brain as nearly incomprehensible. Now, however, the brain is beginning to relinquish its secrets. Scientists have learned more about the brain in the last 10 years than in all previous centuries because of the accelerating pace of research in neurological and behavioral science and the development of new research techniques. As a result, Congress named the 1990s the Decade of the Brain. At the forefront of research on the brain and other elements of the nervous system is the National Institute of Neurological Disorders and Stroke (NINDS), which conducts and supports scientific studies in the United States and around the world.

The Architecture of the Brain

The brain is like a committee of experts. All the parts of the brain work together, but each part has its own special properties. The brain can be divided into three basic units: the forebrain, the midbrain, and the hindbrain.

Figure 1.1. Know Your Brain

The hindbrain includes the upper part of the spinal cord, the brain stem, and a wrinkled ball of tissue called the cerebellum (1). The hindbrain controls the body’s vital functions, such as respiration and heart rate. The cerebellum coordinates movement and is involved in learned rote movements. When you play the piano or hit a tennis ball you are activating the cerebellum. The uppermost part of the brainstem is the midbrain, which controls some reflex actions and is part of the circuit involved in the control of eye movements and other voluntary movements. The forebrain is the largest and most highly developed part of the human brain, it consists primarily of the cerebrum (2) and the structures hidden beneath it.

When people see pictures of the brain it is usually the cerebrum that they notice. The cerebrum sits at the topmost part of the brain and is the source of intellectual activities. It holds your memories, allows you to plan, enables you to imagine and think. It allows you to recognize friends, read books, and play games.

The cerebrum is split into two halves (hemispheres) by a deep fissure. Despite the split, the two cerebral hemispheres communicate with each other through a thick tract of nerve fibers that lies at the base of this fissure. Although the two hemispheres seem to be mirror images of each other, they are different. For instance, the ability to form words seems to lie primarily in the left hemisphere, while the right hemisphere seems to control many abstract reasoning skills.

Figure 1.2. Forebrain

Figure 1.3. Midbrain

For some as-yet-unknown reason, nearly all of the signals from the brain to the body and vice-versa cross over on their way to and from the brain. This means that the right cerebral hemisphere primarily controls the left side of the body and the left hemisphere primarily controls the right side. When one side of the brain is damaged, the opposite side of the body is affected. For example, a stroke in the right hemisphere of the brain can leave the left arm and leg paralyzed.

The Geography of Thought

Each cerebral hemisphere can be divided into sections, or lobes, each of which specializes in different functions. To understand each lobe and its specialty we will take a tour of the cerebral hemispheres, starting with the two frontal lobes (3), which lie directly behind the forehead. When you plan a schedule, imagine the future, or use reasoned arguments, these two lobes do much of the work. One of the ways the frontal lobes seem to do these things is by acting as short-term storage sites, allowing one idea to be kept in mind while other ideas are considered. In the rearmost portion of each frontal lobe, there is a motor area (4), which helps control voluntary movement. A nearby place on the left frontal lobe called Broca’s area (5) allows thoughts to be transformed into words.

Figure 1.4. Hindbrain

When you enjoy a good meal—the taste, aroma, and texture of the food—two sections behind the frontal lobes called the parietal lobes (6) are at work. The forward parts of these lobes, just behind the motor areas, are the primary sensory areas (7). These areas receive information about temperature, taste, touch, and movement from the rest of the body. Reading and arithmetic are also functions in the repertoire of each parietal lobe.

Two areas at the back of the brain are at work, these lobes are called the occipital lobes (8), process images from the eyes and link that information with images stored in memory. Damage to the occipital lobes can cause blindness.

The last lobes of the cerebral hemispheres are the temporal lobes (9), which lie in front of the visual areas and nest under the parietal and frontal lobes. Whether you appreciate symphonies or rock music, your brain responds through the activity of these lobes. At the top of each temporal lobe is an area responsible for receiving information from the ears. The underside of each temporal lobe plays a crucial role in forming and retrieving memories, including those associated with music. Other parts of this lobe seem to integrate memories and sensations of taste, sound, sight, and touch.

The Cerebral Cortex

Coating the surface of the cerebrum and the cerebellum is a vital layer of tissue—the thickness of a stack of two or three dimes. It is called the cortex, derived from the Latin word for bark. Most of the actual information processing in the brain takes place in the cerebral cortex. When people talk about gray matter in the brain they are talking about this thin rind. The cortex is gray because nerves in this area lack the insulation that makes most other parts of the brain appear to be white. The folds in the brain add to its surface area and, therefore, increase the amount of gray matter and the quantity of information that can be processed.

The Inner Brain

Deep within the brain, hidden from view, lie structures that are the gatekeepers between the spinal cord and the cerebral hemispheres. These structures not only determine a person’s emotional state, but also modifies their perceptions and responses depending on that state, and allow them to initiate movements that you make without thinking about them. Like the lobes in the cerebral hemispheres, the structures described below come in pairs: each is duplicated in the opposite half of the brain.

The hypothalamus (10), about the size of a pearl, directs a multitude of important functions. It wakes you up in the morning and gets the adrenaline flowing during a test or job interview. The hypothalamus is also an important emotional center, controlling the molecules that make you feel exhilarated, angry, or unhappy. Near the hypothalamus lies the thalamus (11), a major clearinghouse for information going to and from the spinal cord and the cerebrum.

An arching tract of nerve cells leads from the hypothalamus and the thalamus to the hippocampus (12). This tiny nub acts as a memory indexer—sending memories out to the appropriate part of the cerebral hemisphere for long-term storage and retrieving them when necessary. The basal ganglia are clusters of nerve cells surrounding the thalamus. They are responsible for initiating and integrating movements. Parkinson disease (PD)—which results in tremors, rigidity, and a stiff, shuffling walk—is a disease of nerve cells that lead into, the basal ganglia.

Figure 1.5. The Innerbrain

Making Connections

The brain and the rest of the nervous system are composed of many different types of cells, but the primary functional unit is a cell called the neuron. All sensations, movements, thoughts, memories, and feelings are the result of signals that pass through neurons. Neurons consist of three parts. The cell body (13) contains the nucleus, where most of the molecules that the neuron needs to survive and function are manufactured. Dendrites (14) extend out from the cell body like the branches of a tree and receive messages from other nerve cells. Signals then pass from the dendrites through the cell body and may travel away from the cell body down an axon (15) to another neuron, a muscle cell, or cells in some other organ. The neuron is usually surrounded by many support cells. Some types of cells wrap around the axon to form an insulating sheath (16). This sheath can include a fatty molecule called myelin, which provides insulation for the axon and helps nerve signals travel faster and farther. Axons may be very short, such as those that carry signals from one cell in the cortex to another cell less than a hair’s width away. Or axons may be very long, such as those that carry messages from the brain all the way down the spinal cord.

Figure 1.6. Making Connection

Scientists have learned a great deal about neurons by studying the synapse—the place where a signal passes from the neuron to another cell. When the signal reaches the end of the axon it stimulates the release of tiny sacs (17). These sacs release chemicals, known as, neurotransmitters (18) into the synapse (19). The neurotransmitters cross the synapse and attach to receptors (20) on the neighboring cell. These receptors can change the properties of the receiving cell. If the receiving cell is also a neuron, the signal can continue the transmission to the next cell.

Figure 1.7. Cell Body

Some Key Neurotransmitters at Work

Acetylcholine is called an excitatory neurotransmitter because it generally makes cells more excitable. It governs muscle contractions and causes glands to secrete hormones. Alzheimer disease (AD), which initially affects memory formation, is associated with a shortage of acetylcholine.

Gamma-aminobutyric acid (GABA) is called an inhibitory neurotransmitter because it tends to make cells less excitable. It helps control muscle activity and is an important part of the visual system. Drugs that increase GABA levels in the brain are used to treat epileptic seizures and tremors in patients with Huntington disease (HD).

Serotonin is a neurotransmitter that constricts blood vessels and brings on sleep. It is also involved in temperature regulation. Dopamine is an inhibitory neurotransmitter involved in the control of mood and complex movements. The loss of dopamine activity in some portions of the brain leads to the muscular rigidity of Parkinson disease (PD). Many medications used to treat behavioral disorders work by modifying the action of dopamine in the brain.

Neurological Disorders

When the brain is healthy it functions quickly and automatically. But, when problems occur, the results can be devastating. Some 50 million people in the United States—one in five—suffer from damage to the nervous system. The NINDS supports research on more than 600 neurological diseases. Some of the major types of disorders include:

Neurogenetic diseases (such as Huntington disease and muscular dystrophy)

Developmental disorders (such as cerebral palsy)

Degenerative diseases of adult life (such as Parkinson disease and Alzheimer disease)

Metabolic diseases (such as Gaucher disease)

Cerebrovascular diseases (such as stroke and vascular dementia)

Trauma (such as spinal cord and head injury)

Convulsive disorders (such as epilepsy)

Infectious diseases (such as acquired immunodeficiency syndrome (AIDS) dementia)

Brain tumors

_____________

This chapter includes text excerpted from Brain Basics: Know Your Brain, National Institute of Neurological Disorders and Stroke (NINDS), February 13, 2020.

Chapter 2 | Overview of Traumatic Brain Injury

Chapter Contents

Section 2.1—Traumatic Brain Injury: Basics

Section 2.2—Classification of Traumatic Brain Injury

Section 2.3—Symptoms of Traumatic Brain Injury

Section 2.4—Potential Effects of Traumatic Brain Injury

Section 2.1 | Traumatic Brain Injury: Basics

This section includes text excerpted from Traumatic Brain Injury: Hope through Research, National Institute of Neurological Disorders and Stroke (NINDS), April 24, 2020.

What Is a Traumatic Brain Injury?

A traumatic brain injury (TBI) can be caused by a forceful bump, blow, or jolt to the head or body, or from an object that pierces the skull and enters the brain. Not all blows or jolts to the head result in a TBI.

Some types of TBI can cause temporary or short-term problems with normal brain function, including problems with how the person thinks, understands, moves, communicates, and acts. More serious TBI can lead to severe and permanent disability, and even death.

Some injuries are considered primary, meaning the damage is immediate. Other outcomes of TBI can be secondary, meaning they can occur gradually over the course of hours, days, or appear weeks later. These secondary brain injuries are the result of reactive processes that occur after the initial head trauma. There are two broad types of head injuries: penetrating and nonpenetrating.

Penetrating TBI (also known as open TBI) happens when an object pierces the skull (for example, a bullet, shrapnel, bone fragment, or by a weapon, such as hammer or knife) and enters the brain tissue. Penetrating TBI typically damages only part of the brain.

Nonpenetrating TBI (also known as closed head injury or blunt TBI) is caused by an external force strong enough to move the brain within the skull. Causes include falls, motor vehicle crashes, sports injuries, blast injury, or being struck by an object.

Some accidents such as explosions, natural disasters, or other extreme events can cause both penetrating and nonpenetrating TBI in the same person.

What Are the Signs and Symptoms of Traumatic Brain Injury?

Seek immediate medical attention if you experience any of the following physical, cognitive/behavioral, or sensory symptoms, especially within the first 24 hours after a TBI:

Physical

Headache

Convulsions or seizures

Blurred or double vision

Unequal eye pupil size or dilation

Clear fluids draining from the nose or ears

Nausea and vomiting

New neurologic deficit, i.e., slurred speech; weakness of arms, legs, or face; loss of balance

Cognitive/Behavioral

Loss of or change in consciousness anywhere from a few seconds to a few hours

Decreased level of consciousness, i.e., hard to awaken

Mild to profound confusion or disorientation

Problems remembering, concentrating, or making decisions

Changes in sleep patterns (e.g., sleeping more, difficulty falling or staying asleep); inability to waken from sleep

Frustration, irritability

Perception/sensation

Light-headedness, dizziness, vertigo, or loss of balance or coordination

Blurred vision

Hearing problems, such as ringing in the ears

Bad taste in the mouth

Sensitivity to light or sound

Mood changes or swings, agitation, combativeness, or other unusual behavior

Feeling anxious or depressed

Fatigue or drowsiness; a lack of energy or motivation

Headache, dizziness, confusion, and fatigue tend to start immediately after an injury, but resolve over time. Emotional symptoms, such as frustration and irritability tend to develop during recovery.

Traumatic Brain Injury in Children

Children might be unable to let others know that they feel different following a blow to the head. A child with a TBI may display the following signs or symptoms:

Changes in eating or nursing habits

Persistent crying, irritability, or crankiness; inability to be consoled

Changes in ability to pay attention

Lack of interest in a favorite toy or activity

Changes in sleep patterns

Seizures

Sadness or depression

Loss of a skill, such as toilet training

Loss of balance or unsteady walking

Vomiting

Effects on